| NPI | 1013405216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 68428) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TN 68428) | |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2025-07-01 |